National Consumer Disputes Redressal
Lic Of India & Anr. vs Smt. Chawali Devi on 3 December, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 2021 OF 2009 (Against the Order dated 27/01/2009 in Appeal No. 1847,1812/2004 of the State Commission Rajasthan) 1. LIC OF INDIA & ANR. Through Ist Branch Manager Shahpura NEm ka Thana Sikar Rajasthan ...........Petitioner(s) Versus 1. SMT. CHAWALI DEVI W/o. Late Puranmal Jat R/o. Dani LambaWali Post Bhopatpura Via Ringas Sikar Rajasthan ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER
For the Petitioner : Mr. Nikhil Jain, Advocate For the Respondent : Mr. D.M. Mathur, Advocate
Dated : 03 Dec 2015 ORDER
PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER
This revision petition has been filed by the petitioners against the order dated 27.01.2009 passed by the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (in short, 'the State Commission') in Appeal No. 182 of 2004 - Smt. Chawali Devi Vs. LIC of India by which, while allowing appeal, order of District Forum dismissing complaint partly was set aside.
2. Brief facts of the case are that Complainant/respondent's husband Pooran Mal Jat had taken four LIC policies from the appellants bearings nos. 192237611, 192475601 (both were not in dispute) 192418539 and 192593257. The case of the complainant respondent in respect of policy bearing no. 192418539 is that on 28.3.99 the deceased had taken the policy for a sum of Rs. 1 lac from the OP/petitioner under Salary Saving Scheme as he was an employee in the Education Deptt. It was further stated in the complaint that the deceased had become ill suddenly on 13.10.01 and he was got admitted in the SMS Hospital, Jaipur and he had died on 10.11.01 while he was being admitted in the hospital. Thereafter claim was preferred by the complainant being the wife and nominee of the deceased with OP but that claim was repudiated through letter dated 31.1.04 (Anx.17) on the ground that at the time of taking the above policy on 31.3.99 the deceased had filled in up a declaration form regarding his health on 25.3.99 in which he had not mentioned that he was suffering from any kind of disease but OP had the sufficient proof to prove the fact that about 8 years back he was suffering from breathlessness, cough c expectoration for which he had consulted a medical man and had taken treatment and since these facts were not disclosed by the deceased deliberately in his declaration form on 25.3.1999 therefore, it was a case of suppression of material facts regarding health on the part of the deceased and on that ground claim was repudiated by the OP. Further, the case of the complainant respondent in respect of policy no. 192593257 is that the deceased had taken this policy from the OP for a sum of Rs. 1 lac on 6.1.2000 and the deceased had died on 10.11.01 and the claim in respect of the above policy was repudiated by the OP through letter dated 31.1.04 on the grounds that at the time of taking the above policy on 6.1.2000 the deceased had filled in up a declaration form regarding his health on 7.1.2000 in which he had not mentioned that he was suffering from any kind of disease but OP had the sufficient proof to prove the fact that about 9 years back he was suffering from breathlessness, cough c expectoration for which he had consulted a medical man and had taken treatment and the second ground upon which the claim was repudiated by the OP was that since when the policy bearing no. 192593257 was taken by the deceased on 6.1.2000 the deceased had not mentioned in the proposal form that he had already taken policy bearing no. 192418539, therefore, from that point of view also misstatement was found and thus claim was repudiated on two grounds as stated above. Alleging deficiency on the part of OP, complainant filed complaint before District forum. OP resisted complaint and reiterated same grounds which were mentioned in the re repudiation letter and submitted that as deceased had suppressed material facts regarding his previous disease and treatment and did not disclose earlier policies while taking policy no. 192593257 claim was rightly repudiated and prayed for dismissal of complaint, learned District Forum after hearing both the parties allowed complaint in respect of policy no. 192418539, but dismissed claim pertaining to policy no. 192593257. Both parties preferred appeal before State Commission and learned State Commission vide impugned order dismissed appeal of OP, but allowed appeal of complainant and directed OP to pay Rs. 1 lac with 9% p.a. interest against which, this revision petition has been filed along with application for condonation of delay.
3. Heard learned Counsel for the parties and perused record.
4. Delay of 42 days has already been condoned by order dated 11.8.2009.
5. Learned Counsel for the petitioner submitted that inspite of proof of suppression of material facts regarding existing disease and treatment and not disclosing earlier policy in the proposal form, learned State Commission has committed error in allowing appeal; hence, revision petition be allowed and impugned order be set aside. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.
6. As far suppression of material facts regarding existing disease and treatment is concerned, learned Counsel for the petitioner has drawn my attention towards history of deceased noted by doctor in which it was mentioned that deceased was having breathlessness, cough c expectoration etc. No doubt, this fact has been mentioned as patient's history, but pettiner has failed to place any document on record regarding treatment of aforesaid breathlessness, cough c expectoration etc. and has not filed any affidavit of concerned doctor who recorded history to prove that this history was given by deceased himself. In such circumstances, only on the basis of recorded history of deceased, it cannot be held that deceased was suffering from breathlessness, cough c expectoration etc. since last 10 years and had taken any treatment. Learned Counsel for the respondent has denied any ailment and also placed reliance on judgment of this Commission in III (2014) CPJ 552 (NC) - SBI Life Insurance Co. Ltd. Vs. Harvinder Kaur & Anr. in which it was observed as under:
"Concerned doctor who allegedly treated insured and recorded that patient was admitted with history of pulmonary hypertension for last two years was not examined by petitioner to prove photocopy of discharge card relied upon by petitioner nor affidavit of doctor has been filed - Foras below were right in declining to rely upon the photocopy of discharge card produced by petitioner to establish that petitioner while obtaining insurance policy concealed the fact that he was suffering from pulmonary hypertension - Repudiation not justified.
7. In the light of aforesaid judgment it becomes clear that petitioner committed deficiency in repudiating claim on this basis and learned State Commission has not committed any error in allowing appeal. Not only this, claim pertaining to another policy No. 192418539 which was allowed by District Forum and appeal filed by OP was dismissed by learned State Commission, but no revision petition was filed challenging order of State Commission. In such circumstances, it becomes clear that when OP has not challenged this finding pertaining to one policy, he is estopped from challenging same finding regarding other policy. OP also made payment of earlier two policies obtained by deceased.
8. Learned Counsel for the petitioner submitted that deceased has mentioned only two previous policies in Column No. 9 of the proposal form while obtaining disputed policy whereas; he was having another policy No. 192418539 before filling up of this form. No doubt, aforesaid policy number was not mentioned in the proposal form and deceased ought to have mentioned this policy, but merely because he omitted to mention one of the policies while mentioning other two policies, it cannot be held that deceased concealed this fact with ulterior motive or for any fraudulent intention particularly when earlier policy was taken under Salary Saving Scheme which was known to the Department as well petitioner. Learned State Commission while allowing appeal of complainant rightly observed as under:
"28. Thus, it I held that the present case was not a case of deliberate suppression of material facts on the part of the deceased and the claim of the complainant appellant was wrongly repudiated by the respondents LIC on wrong assumption and in an arbitrary manner. Hence repudiation of the claim of the complainant appellant was not justified regarding his health as well as non-mentioning the policy bearing no. 192418539 in the proposal form and it had amounted to deficiency in service on the part of the respondents LIC and the findings of the District forum dismissing the complaint of the complainant appellant are suffering from basic infirmity and illegality and are not based on correct appreciation of entire materials and evidence available on record and the appeal deserves to be allowed.
9. Learned Counsel for the petitioner has placed reliance on judgment in R.P. No.1982 to 1990 of 2004 - LIC of India & Anr. Vs. Balbir Kaur in which repudiation of claim was upheld on account of suppression of 8 policies. In the aforesaid case, policies were taken just before 4 months of death with double accident benefit and deceased committed suicide and deceased was having income of Rs.1,60,000/- per year but obtained polices with premium of Rs.55,000/- per year. Facts of the aforesaid case are not applicable to present case because in the case in hand he had already disclosed earlier two policies, but failed to disclose only one policy obtained in Salary Saving Scheme that too only for Rs. 1 lac. Learned Counsel for the petitioner also placed reliance on judgment of this Commission in R.P. No. 382 of 2011 - LIC & Anr. Vs. Vidya Devi & Anr. in which repudiation of claim on account of suppression of earlier 3 policies valuing 5 lakhs was upheld as deceased obtained policy by playing fraud. Aforesaid case is also not applicable in the facts and circumstances of the present case because there was omission of declaration of only one policy obtained under Salary Saving Scheme and had already declared earlier two policies.
10. In the light of aforesaid discussion, I do not find any illegality, irregularity or jurisdictional error in the impugned order and revision petition is liable to be dismissed.
11. Consequently, revision petition filed by the petitioner is dismissed with no order as to costs.
......................J K.S. CHAUDHARI PRESIDING MEMBER